Lead Specialist, Naven Health Billing and Collections

Delivering an exceptional infusion experience, everywhere. Delivering on our unyielding commitment, always. Naven Health is a nationwide home infusion nursing network and clinical platform focused on delivering specialized, truly exceptional infusion care. With over 1,600 team members, including over 1,500 nurses, we are a company aligned to the values of the nurses at our center – to provide an exceptional infusion experience, everywhere.

Naven Health delivers home infusion services for a broad range of specialized therapies, as well as clinical trial services and special programs for pharmaceutical manufacturers. Joining the Naven Health team means being a part of a dynamic and growing organization that is dedicated to our customers, our teammates, and the patients we serve.

Job Description Summary: Acts as a lead resource for billing and collections activities while performing the full duties of a Billing/Collections Specialist. Independently manages complex billing issues, supports workflow coordination and peer training, and helps resolve escalated claim and payment concerns. Ensures accurate, timely billing for authorized services, products, and drugs in accordance with payer requirements, contracts, fee schedules, and established policies.

This position has no supervisory responsibilities. Job Description: Job Responsibilities (listed in order of importance and/or time spent) Serves as a lead resource and subject matter expert for billing and collections processes, handling complex issues independently within established procedures and practices. Coordinates day-to-day billing workflow, supports colleagues with questions, and assists with training and onboarding of new team members without exercising supervisory authority.

Submits timely and accurate claims and invoices to payers for products and services provided, including professional claims billed on the CMS-1500 claim form. Correctly determines quantities and prices for drugs billed. Verifies patient insurance eligibility and benefits using payer portals and other approved resources.

Verifies that services and products are correctly authorized and that required documentation is on file before billing. Confirms that services and products were properly ordered and provided before claim submission. Reviews payer contracts and fee schedules and bills services, products, and drugs according to applicable terms and reimbursement requirements.

Reviews, researches, and resolves claim denials, rejections, underpayments, and other billing discrepancies, including completing follow-up or corrected claim activity as appropriate. Follows up on submitted claims and invoices to support prompt and timely payment. Contacts payers to verify that submitted claims were received and are in process, and documents follow-up activity accurately.

Confirms that all required billing documentation is complete and accurate before claim submission. Reviews aged receivables and takes timely follow-up action to support departmental accounts receivable goals. Researches payments to support accurate posting and resolution of payment variances. Uses critical thinking and sound judgment to identify issues, determine next steps, and escalate concerns when needed.

Communicates professionally and clearly with payers, internal partners, patients, and other stakeholders, while protecting confidential information. Works independently, manages priorities, and maintains productivity and accountability in a remote work setting. Adheres to regulatory and payer guidelines, company policies, and department procedures.

Supervisory Responsibilities Does this position have supervisory responsibilities? (i.e., hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No X Basic Education and/or Experience Requirements High school diploma or equivalent. At least two (2) years of insurance billing experience, including experience billing professional claims on the CMS-1500 claim form.

Experience with claim denials, insurance eligibility verification, and payer portals.

Basic Qualifications

Demonstrated ability to read and apply payer contracts and fee schedules when billing services, products, and drugs. Experience identifying billing or operational issues and recommending practical solutions.Strong critical-thinking, problem-solving, and organizational skills, with attention to detail and accuracy. Professional written and verbal communication skills.

Ability to work independently, prioritize work, and meet expectations in a remote setting. Basic proficiency with Microsoft Excel and Microsoft Word. Physical Demand Requirements Travel Requirements: (if required) none Preferred Qualifications & Interests (PQIs) Previous Infusion Reimbursement or Intake/Admissions experience.

Experience with multiple payer types and web-based payer portals. This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties. Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.

Pay Range

is $19.16-$31.92 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -my. Flex. Pay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Naven Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.